Kaplan Meier failure estimates of smear-positive re-treatment after treatment default, stratified by smear conversion prior to defaulting (adjusted for time to default).

<p>Kaplan Meier failure estimates of smear-positive re-treatment after treatment default, stratified by smear conversion prior to defaulting (adjusted for time to default).</p

Kaplan Meier failure estimates of re-treatment for smear-positive tuberculosis by index episode sputum smear grading and treatment outcome.

<p>Kaplan Meier failure estimates of re-treatment for smear-positive tuberculosis by index episode sputum smear grading and treatment outcome.</p

Multivariable analysis of index episode risk factors for subsequent smear-positive tuberculosis re-treatment (N = 1,733).

<p>PY = Person-years.</p><p>CI = Confidence Interval.</p>*<p>Adjusted for the other factors shown in the table.</p>†<p>Smear grade at start of treatment:</p><p>Smear 3+: Any of the two initial smears was 3+, i.e. >10 acid-fast bacilli (AFB) per 1 high-power field (HPF).</p><p>Smear 2+: Any of the two initial smears was 2+, i.e. 1–10 AFB per 1 HPF, but none of them was 3+.</p><p>Smear 1+: Any of the two initial smears was 1+, i.e. 10–99 AFB per 100 HPF, but none of them was 2+ or 3+.</p>‡<p>Test for trend.</p

Univariable analysis of index episode risk factors for subsequent smear-positive tuberculosis re-treatment (N = 2,136).

<p>PY = Person-years.</p><p>CI = Confidence Interval.</p>*<p>Smear grade at start of treatment:</p><p>Smear 3+: Any of the two initial smears was 3+,i.e. >10 acid-fast bacilli (AFB) per 1 high-power field (HPF).</p><p>Smear 2+: Any of the two initial smears was 2+,i.e. 1–10 AFB per 1 HPF, but none of them was 3+.</p><p>Smear 1+: Any of the two initial smears was 1+,i.e. 10–99 AFB per 100 HPF, but none of them was 2+ or 3+.</p>†<p>Test for trend.</p

Treatment outcomes at re-treatment stratified by index episode treatment outcome (N = 291 re-treatment cases).

<p>Treatment outcomes at re-treatment stratified by index episode treatment outcome (N = 291 re-treatment cases).</p

Ascertainment of subsequent episodes of re-treatment via record linkage and manual review for the study.

<p>Ascertainment of subsequent episodes of re-treatment via record linkage and manual review for the study.</p

Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management

<div><p>Objective</p><p>To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management.</p><p>Methods</p><p>A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1^st 2000 until 31^st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital.</p><p>Findings</p><p>Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335).</p><p>Conclusions</p><p>The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.</p></div

WHO standard case management of pneumonia defined by age groups and severity of disease.

<p>WHO standard case management of pneumonia defined by age groups and severity of disease.</p

Summary of the situational analysis carried out prior to the implementation of the child lung health programme (CLHP), intended interventions, output indicators and outputs achieved following the CLHP intervention.

<p>Summary of the situational analysis carried out prior to the implementation of the child lung health programme (CLHP), intended interventions, output indicators and outputs achieved following the CLHP intervention.</p

Deaths before and after 24

<p>^*Infants <2 months were not categorized or analyzed by separate degree of severity.</p